In most of the developing world acute and chronic diarrheal diseases constitute the major cause of death in children, resulting in immeasurable losses for poor, rural people. Despite the endemic nature of gastrointestinal diseases, and their direct impact on infant health and family survival, the specific role human culture plays in the natural history of childhood diarrhea remains poorly understood and documented. This research, as part of an ongoing, multi-disciplinary project, will test the hypothesis that culture--or human behavioral patterns and belief systems--play a major role in the occurrence and management of gastrointestinal infections in infants and children in northeastern Brazil. We propose to investigate: 1) the socio-cultural context and epidemiologic risk factors which impact on the occurrence of diarrheal illness; 2) how gastrointestinal illnesses are perceived and defined by village people and what these poor, rural people do to prevent and treat childhood diarrhea (specifically, traditional medical practices of indigenous healers) in order to establish actual attack rates and design a culturally acceptable approach to prevention and management; and 3) determine the impact of these health-related beliefs and behavior on the health-seeking strategies of families when coping with diarrheal illness. This in-depth community/family based study will utilize both qualitative and quantitative methodologies from the disciplines of medical anthropology and epidemiology together with medical research laboratory techniques and quantitative microbiologic testing. Research findings will form the basis of a model, culturally appropriate oral dehydration program which integrates the traditional healer as a primary care provider of early, in-home treatment and prevention of diarrheal diseases, and also incorporate important microbiologic findings of environmental (especially water) contamination and predominant microbial etiologies.